As our profession evolves, competency in a rapidly changing healthcare environment remains a key component of excellent nursing care. Competency gives us confidence to care for our patients. But developing competency is but one step to becoming an expert nurse. Nurses’ expertise grows over the years — a product of experiences (Saver, 2009). The importance of nursing practice expertise in modern and effective health services and its impact on patients, colleagues and health care services is internationally recognized (Manley and Webster, 2006).
Expert nurses - nurse consultants, specialist nurses and clinical leaders - possess expertise that spans and integrates interpersonal and technical components and deliver against a number of requirements. These include improving patient care and the individual patient experience, meeting government targets in practice, and contributing to organisational innovation and service improvement. Nurse consultants have an additional strategic responsibility to deliver on these areas.
Expert nursing is considered an important part of achieving high-quality patient care (Aitken 2003). The benefits of expert nursing practice are far-reaching, yet we know little how to promote it and what conditions foster its development (Williams, 1996, p. iv). There is a lack of formalized systematic approaches to foster nursing practice-based skill development and continuous learning beyond the initial orientation stages and beginner stages, despite the potential for superior outcomes associated with expert nursing performance (Santucci, 2004).
Adding to the problem is the absence of a common definition of what constitutes expert practice in nursing, despite years of nursing research yielding a rich description of expert performance in nursing (Benner, 1984, 1994; Benner & Benner, 1999; Haag-Heitman, 1999; McGregor, 1991). Background of the Study The researcher has been in the Radiology Nursing field for more than 2 years. She has been working in a private tertiary hospital and encounters fellow nurses everyday.
She knows of Nursing Supervisors who have worked long years in the nursing service as well as nurses who are just starting a career path. The knowledge needed to become an expert nurse has long been discussed in the halls of academia as well as halls of healthcare system, but still the question remain, who is an expert nurse? What characteristics are needed for a professional nurse to hold such title? Dr.
Patricia Benner was the one who introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. This theory changed the profession’s understanding of what it means to be an expert, placing this designation not on the nurse with the most highly paid or most prestigious position, but on the nurse who provided the most exquisite nursing care.
According to Patricia Benner’s model From Novice to Expert provides a theory of skill acquisition to examine the transition of a novice nurse who is primarily focused on task oriented professional nursing care to the highest level, the professional nurse expert, who is able to multitask, has proficiency in the clinical area, high level of intuition, and analytic ability and can apply these characteristics in new situations by recalling former experiences.
There are five stages of the socialization model; novice, advanced beginner, competent, proficient, and expert (Benner, 1982). Benner and her colleagues say that at the same time nurses are engaged in various situations, learning from them, they develop “skills of involvement” with patients and families. Benner and her colleague define skills of involvement as “knowing how close or distant to be with patients and families in critical times of threat and recovery” (Benner P, Tanner C, Chesla C. 2009). These skills are essential for nurses to manage the stress that comes with their careers. Faced with an emotionally challenging patient, an overprotective parent, or a relative who disagrees with a loved one’s end-of-life decision making, nurses must know how to handle the situation to meet the person’s needs while not losing themselves in the process.
As nurses develop expertise, particular changes in performance occur, including movement from abstract to concrete, from viewing a situation in bits to viewing it as a whole, and from detached observation to involved performer (Altmann TK, 2007). It is these changes that underlie nurses’ clinical practice experiences. These cumulative experiences help nurses move through the five stages described, Benner’s stages of clinical competence.
Factors that have been found to positively influence the progression of skill development and acquisition of excellence in many practice domains include time, experience, personal engagement, and sustained practice efforts within a supportive and focused learning environment (Ericsson, 2002). A lack of systematic examination and understanding of these factors persists as they relate to the domain of nursing. The purpose of this study was to examine factors that facilitate expert skill development and performance among practicing nurses working in hospital.